Case 5
“My hand hurts”

Who is your patient?

80 year old male veteran with ESRD secondary to hypertension, and superimposed severe acute kidney injury in the setting of sepsis, undergoes a left brachiocephalic AVF creation in August 2016 and initiates hemodialysis using his well developed fistula with a high flux dialyzer in October 2016. A year later, he starts to notice the onset of pain, tingling, and numbness in digits 2-4 of his left hand that progressively worsen especially during his dialysis treatments or when he exercises.

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